• Journal of Chest Surgery
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• 제40권12호
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• pp.837-842
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• 2007

배경: 미숙아는 흔히 동맥관의 폐쇄가 지연되어 혈역학적으로 의미 있는 좌우단락을 초래함으로 환아의 성장 및 정상 발육에 악영향을 미친다. 저자들은 액와 소개흉술을 통한 미숙아 동맥관 개존증 폐쇄의 효과에 대해 알아보고자 하였다. 대상 및 방법: 2002년 4월부터 2006년 10월까지 동맥관 개존증을 동반한 재태기간 37주 미만의 미숙아 중 인도메타신 부적응증 또는 치료 실패 등으로 수술적 교정을 받은 20명을 대상으로 하였다. 출생 당시 재태기간은 25+3에서 34+6주 사이로 평균 28.8+3.4주이었고, 출생 후 평균 $15.6{\pm}6.3$일째에 수술하였다. 수술 당시의 체중은 680에서 2,100 g 사이로 평균 $1,174{\pm}416\;g$이었는데 이 중 1,500 g 미만은 16명이었고 1,000 g 미만은 9명이었다. 수술은 모두 신생아 중환자실에서 이루어졌는데 측와위에서 왼팔을 현수시킨 자세로 길이 $2{\sim}3\;cm$의 액와 소개흉술을 통하여 접근하였다. 동맥관 크기는 평균 $3.8{\pm}0.3\;mm$로 동맥관의 폐쇄는 주로 클립을 사용하였는데, 2예에서 박리 중 동맥관 파열로 동맥관 분리술(division)을 시행하였다. 결과: 술 전부터 인공호흡기에 의존해 온 환아 12명 중 10명이 술 후 호흡기 증상의 호전과 함께 평균 9.7일 사이에 인공호흡기 이탈이 가능하였다. 수술과 직접적으로 연관된 사망이나 합병증은 없었으나 병원 내 만기 사망이 2예에서 있었는데 1예는 술 후 41일째 폐렴으로, 나머지 1예는 술 후 131일째 패혈증으로 사망하였다. 결론: 액와 소개흉술을 통한 미숙아 동맥관 개존증의 폐쇄는 혈역학적 불안정성을 개선하여 미숙아의 성공적인 성장 및 정상 발달에 도움이 되었다. 수술의 침습도 및 이에 따른 위험성은 매우 적어 조기에 적극적인 외과적 요법이 권장된다.

• Clinical and Experimental Pediatrics
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• 제56권9호
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• pp.396-400
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• 2013

Purpose: The purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA) by using an Amplatzer vascular plug (AVP). Methods: We reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared. Results: The mean age of the patients was $54.9{\pm}45.7$ months old. The PDAs were of type C (n=5), type D (n=12), and type E (n=3). The mean pulmonary end diameter of the PDA was $1.7{\pm}0.6$ mm, and the aortic end diameter was $3.6{\pm}1.4$ mm. The mean length was $7.3{\pm}1.8$ mm. We used 3 types of AVP devices: AVP I (n=5), AVP II (n=7), and AVP IV (n=8). The ratio of AVP size to the pulmonary end diameter was $3.37{\pm}1.64$, and AVP size/aortic end ratio was $1.72{\pm}0.97$. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P=0.002). The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter ($1.10{\pm}0.31$, P=0.032). Conclusion: Transcatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

• 대한수의학회지
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• 제47권4호
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• pp.461-467
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• 2007

A 6-year-old female Maltese dog (body weight 2.0 kg) was referred to the Veterinary Teaching Hospital, Kangwon National University with primary complaints including exercise intolerance and heart murmur. Based on clinical and diagnostic findings including grade V/VI left basal continuous murmur, bounding femoral pulsation, left ventricular enlargement pattern in electrocardiogram, cardiomegaly with aortic bulging on the thoracic radiography, and shunt flow between aorta and pulmonary artery on the echocardiography, the dog was diagnosed as the left-to-right patent ductus arteriosus. The patent ductus arteriosus was successfully treated by lodging a single embolization coil with transjugular approach.

• Journal of Chest Surgery
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• 제18권4호
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• pp.542-548
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• 1985

In 1966 Porstmann was the first to successfully apply a new method by which a PDA was closed by a Plug transported by catheters through the femoral artery. We Successfully closed the isolated PDA in 6 consecutive patients using the transfemoral catheter method. To Perform this technique more safely and reliably, some instrumental and technical improvements was made. The Indications for this method have been Expanded to include the cylindrical or window Type ductus as well as the conical-shaped ductus. Classification into three Groups of the configuration of the by Angiography has been useful in selecting the shape of the closing plug. Whenever feasible, we consider the catheter technique to be the method of choice to close the ductus.

• Clinical and Experimental Pediatrics
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• 제52권4호
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• pp.488-493
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• 2009

목 적 : 경피적 동맥관 폐쇄술은 동맥관 개존증의 표준 치료로 시행되고 있다. 저자들은 동맥관의 최소 직경(MD)과 체혈류와 폐혈류의 비(Qp/Qs ratio)를 기준으로 하여 선택한 각각의 기구들로 경피적 동맥관 폐쇄술 시행한 후 추적 관찰 결과를 비교, 분석하여 새로운 기구 선택 기준의 효용성과 안전성을 알아보았다. 방 법 : 2003년 2월부터 2006년 1월까지 본원에서 동맥관 개존증을 진단받고 동맥관의 크기 및 Qp/Qs 비에 따라 CDC, PNO, ADO를 선택하여 경피적 동맥관 폐쇄술을 시행받은 138명의 환자를 대상으로 하였다. 그리고 2000년 2월부터 2003년 1월까지 본원에서 DO, PNO로 경피적 동맥관 폐쇄술을 시행받은 89명의 환자들을 대조군으로 설정하였다. 시술 전 환자의 임상적, 혈역학적 지표들을 확인하였고 시술 후 1일, 1개월, 6개월, 12개월, 그리고 12개월 이후 잔류 단락 유무 및 합병증을 평가, 비교하였다. 결 과 : 대상군 138명 모두에서 시술에 성공하였고 기구 색전도 없었으며 시술 후 12개월 이후 잔류 단락이 남아있지 않았다. 주요 합병증의 빈도는 대상군 138명 중 0명(0%), 대조군 89명 중 7명(7.9%)이었고(P<0.05) 전체 합병증의 빈도도 대상군 138명 중 2명(1.4%), 대조군 89명 중 8명(9.0%)으로(P=0.001) 대상군에서 대조군에 비하여 의미 있게 합병증의 빈도가 낮았다. 결 론 : 과거에 경피적 폐쇄가 어려웠던 큰 크기의 동맥관 개존에 ADO를 사용하게 되고 이전 기구들의 단점들이 개선된 최근 기구들을 각각의 특성에 적합하게 전략적으로 선택하여 시술함으로써 경피적 동맥관 폐쇄술의 결과가 향상되었고 더욱 안전하고 완전한 효과를 나타내게 되었다.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1139-1145
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• 1990

Seven infants less than age 3 months underwent patch aortoplasty and tube graft bypass for relief of coarctation of aorta. All had intractable congestive heart failure, despite aggressive medical therapy Each infant had other cardiac anomalies including patent ductus arteriosus, ventricular septal defect, atrial septal defect and congenital mitral stenosis. All patients underwent closure of the ductus arteriosus and patch angioplasty of the aorta to produce a luminal diameter of at least 15mm or tube graft interposition utilizing the Gortex tube graft diameter larger than 10mm. In 5 patients who had ventricular defect, they underwent pulmonary arterial banding. &ere was one hospital death 17 days after operation secondary to the hydronephrosis and renal failure. Hospitalization was less than 10 days after operation except one case. In 3 patients who had associated VSD, open heart surgery[VSD closure+PA debanding]was done without difficulty. Surgical repair of critical coarctation of the aorta in infants can safely be offered despite the poor preoperative condition and presence of other cardiac anomalies.

• Journal of Chest Surgery
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• 제23권5호
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• pp.953-961
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• 1990

Congenitally corrected transposition of the great arteries is a rare congenital heart anomaly, in isolation, has no hemodynamic consequences. It is usually associated with one or more of a variety of intracardiac lesions, ventricular septal defect, valvular or subvalvular pulmonary stenosis, and deformity of the systemic atrioventricular valve with insufficiency. This report describes a successful two stage operation for congenitally corrected transposition, [SLL] type, with ventricular septal defect, pulmonary atresia, persistent ductus arteriosus, and atrial septal defect. A 9 years old patient underwent modified Blalock-Taussig operation because of severe pulmonary hypoplasia. 2 years later a corrective operation, direct closure of ASD and PDA, VSD closure with Dacron patch, Enlargement of left pulmonary artery with pericardial patch and Relief of ROTO with Rastelli procedure could be successfully performed without complication.

• Journal of Chest Surgery
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• 제17권4호
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• pp.593-606
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• 1984

With the ligation of patent ductus arteriosus by Gross in 1938, surgeons first entered the field of congenital heart disease. Interruption of a ductus is one of the most satisfactory and curative operations in the field of surgery for congenital heart disease. 27 cases of isolated patent ductus arteriosus were operated from Jan. 1978 to July 1984 at the Department of Thoracic & Cardiovascular Surgery in Kyung-Hee University Hospital. Retrospective clinical analysis of these patients were: 1. Sex ratio, female: male, was 2:1. 2. Mean age at operation was 9.85\ulcorner.58 years. The youngest patient was a 23 month-old girl and the oldest one was a 24 year-old male. 3. More than half of the patients had less than 50 percentile of growth retardation. 4. Chief complaints of the patients were frequent URI [52%], dyspnea on exertion [33%], generalized weakness [22%], palpitation [7%], but 7 patients [26%] had no subjective symptoms. 5. Continuous machinery murmur could be heard at the 2nd or 3rd intercostal space on the left sternal border in 22 patients [81%]. The other S patients made systolic murmur with accentuation of the second heart sound and those were associated with pulmonary hypertension. 6. Radiologic findings of Chest P-A were cardiac enlargement in 15 patients [55%], enlargement of pulmonary conus and/or increasing density of pulmonary vascularity in 20 patients [74%]. 7. Electrocardiographic findings of the patients were within normal limit in 13 patients [48%], LVH in 4 patients [15%], biventricular hypertrophy in 3 patients [11%]. 8; echocardiogram was obtained from 11 patients. Ductus was directly visualized in 7 patients. Left atrial enlargement is the secondary change of left to right shunt, 10 patients had LA/Ao ratio more than 1.2. 9. Cardiac catheterization performed in 25 patients. The mean value of the results were:SO2[PA-RV]= 14.72\ulcorner6.01%, Qp/Qs=2.22\ulcorner.80, peak systolic pulmonary arterial pressure=48.28\ulcorner1.60 mmHg. 10. 26 patients were operated through the left posterolateral thoracotomy: closure of ductus by double ligation in 14 cases, triple ligation in 5 cases, and division with suture in 8 cases. One patient suffer from aneurysmal rupture of main pulmonary artery, endocarditis, hemopericardium was treated with cardiopulmonary bypass via median sternotomy and closure of ductus through the ruptured main pulmonary artery. 11.There was no death associated with the operation, but 3 cases were experienced with intraoperative rupture around the ductus resulting in massive bleeding. The other complications were transient hoarseness in one patient, atelectasis in left lower lobe in 3 patients, and postoperative systemic hypertension in 4 patients with unknown etiology. 12. Pulse pressure was reduced, 11.47+5.92 mmHg, postoperatively, as compare to preoperative status. 13. Intraoperative wedge lung biopsy from lingular segment for the evaluation of the pulmonary vascular disease was taken in S patients with severe pulmonary hypertension. The result was Heath-Edward grade I in one case, grade II in two cases, and grade III in two cases.

• Journal of Chest Surgery
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• 제28권2호
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• pp.136-142
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• 1995

A clinical study was performed on 69 cases of isolated PDA surgically treated at the Department of Thoracic and Cardiovascular surgery of Kyung-Hee University Hospital from Mar. 1986 to Feb. 1994. Retrospective clinical analysis of these patients were as follows: 1.23 males and 46 females ranged in age from 16 days to 49 years. [mean 8.69yrs.,sex ratio M:F=1:2 2. Chief complaints were frequent URI in 44%, dyspnea on exertion in 16%,palpitation in 8%, easy fatigability in 6%, and no subjective symptoms in 26%. 3. On auscultation, typical continuous machinery murmur heard in 84%, and systolic murmur in 16% on Lt 2nd or 3rd intercostal space. 4. Simple chest x- ray showed increased pulmonary vascularity in 67%, cardiomegaly in 61%,and within normal limit in 16%. 5. EKG findings were LVH in 42%, biventricular hypertrophy in 17%, RVH in 3%, and within normal limit in 38%. 6. Echocardiogram was performed from all patient, and direct visualization of ductus in 93% 7. Cardiac catheterization was performed in 39 patients. The mean value of the results were;Differance SaO2[MPA-RV =11.03$\pm$ 5.26%,Qp/Qs=2.44$\pm$1.35,systolic pulmonary arterial pressure=40.69 $\pm$ 17.69mmHg. 8. 66 patients were operated through the left posterolateral thoracoctomy ; closure of ductus by double ligation in 43 cases, triple ligation in 23 cases.3 patients were operated by simple closure under cardiopulmonary bypass. 9. There was no death associated with the operation. The operative complications were atelectasis in 8 cases, pneumonia in 4 cases recannalization in 2 cases, and hoarseness in one case. 10. Systemic diastolic pressure was increased 8.12$\pm$ 0.13mmHg, and pulse pressure was decreased about 9.52 $\pm$ 1.87mmHg.

• Journal of Chest Surgery
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• 제12권3호
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• pp.233-239
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• 1979

Ventricular septal defect associated with patent ductus arteriosus is well known cardiac anomaly that can be treated successfully by operation. This anomaly is found at low frequency. Seven cases of the combined malformation were operated on during the period from 1959 to 1978 in the Department of Thoracic Surgery, Seoul National University Hospital. Right heart catheterization and retrograde aortogram can diagnose the disease correctly. Staged operation in one case and one-stage operation in 5 patients were done. In all cases of the open heart surgery the closure of the ductus was done by transpulmonary suture of the PDA opening. Among 6 patients of the open heart surgery 2 operative death [33.3%] and one late death [total 50%] were noted. Four type II and one type I and one Type IV VSDs were found. In one case the anomaly was accompanied with aortic insufficiency by herniation of the right coronary cusp through Type I VSD.